| NPI | 1013938976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0066843) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2024-11-22 |