| NPI | 1821471665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 299959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 60373) |
| 207Q00000X Family Medicine (Licence: MI 4301503619) | |
| 207Q00000X Family Medicine (Licence: FL ME149501) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2025-08-27 |