| NPI | 1659319887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 21575) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD29229) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2026-07-13 |