| NPI | 1659007557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 80267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0106313) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2026-08-19 |