| NPI | 1992058408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME122334) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME1223334) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2020-07-21 |