| NPI | 1386795375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME25334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 25334) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2017-03-29 |