| NPI | 1811909583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 25281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME94466) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2025-11-21 |