| NPI | 1902910664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME93871) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME93871) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2021-08-24 |