| NPI | 1144314873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME0045001) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME0045001) |
| 208D00000X General Practice (Licence: FL ME0045001) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: FL ME0045001) | |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL ME0045001) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-11-28 |