| NPI | 1689376865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 111553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME176052) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-07-02 |