| NPI | 1649925249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME180083) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 24578) |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2026-05-20 |