| NPI | 1699351049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX V3130) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME164353) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2024-12-20 |