| NPI | 1235282815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 51304) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0051304) |
| 261QP2300X Clinic/Center, Primary Care (Licence: FL ME 51304) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2010-07-13 |