| NPI | 1730256116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME91687) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME 91687) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME91687) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-10-27 |