| NPI | 1558399048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME93041) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME 93041) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2017-04-27 |