| NPI | 1881739290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME117493) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101237573) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME117493) | |
| 208D00000X General Practice (Licence: FL ME117493) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2021-03-29 |