| NPI | 1043410871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A105161) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A105161) |
| 208D00000X General Practice (Licence: CA A105161) | |
| 208D00000X General Practice (Licence: FL ME156058) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2024-08-28 |