| NPI | 1467558858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME142056) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME142056) |
| 207Q00000X Family Medicine (Licence: CA a65963) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA A65963) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: IA 39375) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-08-10 |