| NPI | 1639495245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME107380) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME107380) |
| 208D00000X General Practice (Licence: FL ME107380) | |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2023-06-14 |