| NPI | 1093985434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: ME DO2302) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: ME DO2302) |
| 208D00000X General Practice (Licence: ME DO2302) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2014-10-16 |