| NPI | 1427277300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME36282) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: FL ME 36282) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME36282) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2015-11-03 |