| NPI | 1184891061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME100524) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME100524) |
| 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL ME100524) | |
| Enumeration Date | 2008-05-10 |
| Last Update Date | 2012-08-30 |