| NPI | 1851041560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME175306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.49524) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2025-07-01 |