| NPI | 1902237704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: FL ME116118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME116118) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2026-04-13 |