| NPI | 1184715708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME63751) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0063751) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-03-16 |