| NPI | 1568014082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME146756) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME146756) |
| 207Q00000X Family Medicine (Licence: FL 29094) | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2023-07-31 |