| NPI | 1578296133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME173337) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351049554) |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2025-05-05 |