| NPI | 1568923712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME174086) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 323286) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2025-07-08 |