| NPI | 1720509565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME166729) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 66685) |
| Enumeration Date | 2017-07-02 |
| Last Update Date | 2025-03-03 |