| NPI | 1235370289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME103459) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME 103459) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2023-10-30 |