| NPI | 1598077729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME175420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 8913) |
| 207Q00000X Family Medicine (Licence: NE 6188) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2025-10-07 |