| NPI | 1538206933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME115118) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME115118) |
| 207R00000X Internal Medicine (Licence: FL ME115118) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2022-01-11 |