| NPI | 1295865871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL ME 78502) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 78502) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-12-27 |