| NPI | 1174941959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME129582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME129582) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: FL ME129582) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: FL ME129582) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2021-10-21 |