| NPI | 1568560795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME44362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0044352) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME0044352) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-07-19 |