| NPI | 1366693921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: FL ME103801) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME103801) |
| 208000000X Pediatrics (Licence: FL ME103801) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2026-01-12 |