| NPI | 1184739898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 0048061) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME48061) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-07-11 |