| NPI | 1609876184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME127827) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: AL 00021488) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2023-10-03 |