| NPI | 1033218821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME874444) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME87444) |
| 208D00000X General Practice (Licence: FL ME87444) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-04-06 |