| NPI | 1770137853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME163951) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019026441) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2023-10-13 |