| NPI | 1962515072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME 33096) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME 33096) |
| 208600000X Surgery (Licence: FL ME 33096) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL ME 33096) | |
| 208D00000X General Practice (Licence: FL ME 33096) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |