| NPI | 1376641902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131492) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME131492) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-03-19 |