| NPI | 1497405633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME169323) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 34570) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2025-04-24 |