| NPI | 1508885476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107142) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 59679) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2025-04-22 |