| NPI | 1609282722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME153523) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 13,569-I) |
| 207Q00000X Family Medicine (Licence: KS 0441252) | |
| 207Q00000X Family Medicine (Licence: FL ME153523) | |
| 208D00000X General Practice (Licence: PR 19,231) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2024-01-18 |