| NPI | 1215323183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME147252) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME147252) |
| 208D00000X General Practice (Licence: CA A155911) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2025-08-15 |