| NPI | 1750558474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 1022303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD445429) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2025-12-03 |