| NPI | 1861842726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 283169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2017033231) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2026-06-17 |