| NPI | 1780316935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-04200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME176097) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2026-03-31 |