| NPI | 1295951374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME45529) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: FL ME45529) |
| 207P00000X Emergency Medicine (Licence: FL ME45529) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL ME45529) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2018-12-17 |