| NPI | 1699838003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME74035) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0074035) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2025-09-08 |