| NPI | 1841638749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 191649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME127509) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2025-11-05 |