| NPI | 1962143867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME179692) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME179692) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-06-25 |