| NPI | 1801525415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 36821) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME164304) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-07-25 |