| NPI | 1366683377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME15582) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A121927) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: CA A121927) | |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2023-08-03 |