| NPI | 1225181365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 016792) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME82020) |
| 208100000X Physical Medicine & Rehabilitation (Licence: ME 016792) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME82020) | |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2025-09-11 |