| NPI | 1366749731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME113185) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 049511) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2025-08-08 |