| NPI | 1407885510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2005-01320) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0072151) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2025-09-08 |