| NPI | 1417064411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ME POD1028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 012968) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2012-02-20 |