| NPI | 1497217905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101285917) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD25874) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-06-17 |