| NPI | 1700846805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME32060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME32060) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME32060) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2021-10-18 |