| NPI | 1538695705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME143081) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OH 35.137210) |
| 207Q00000X Family Medicine (Licence: OH 35.137210) | |
| 208600000X Surgery (Licence: OH 35.137210) | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2026-02-27 |