| NPI | 1447560818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME160481) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301513060) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2025-09-29 |