| NPI | 1093161143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134493) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME134493) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2025-07-15 |