| NPI | 1316206964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME156931) |
| Additional Taxonomies | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL ME156931) |
| 208600000X Surgery (Licence: FL ME156931) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2024-05-21 |