| NPI | 1700446341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME147257) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME147257) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2026-05-11 |