| NPI | 1972865384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 34546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME143399) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2025-09-29 |