| NPI | 1770158867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-03545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME167062) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2025-12-30 |