| NPI | 1164831350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME163714) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2024-05-29 |