| NPI | 1245319391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME91067) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: FL ME91067) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-06-14 |