| NPI | 1447918065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: ME CNP211421) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: NH 087718-23) |
| Enumeration Date | 2021-12-01 |
| Last Update Date | 2025-12-03 |