| NPI | 1285166157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142887) |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: FL ME142887) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2022-04-03 |