| NPI | 1922079573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME27841) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME27841) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2021-10-20 |