Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2005-08-15
- Last updated
- 2023-03-07
Specialties
Licenses
- License NH
- 6910
Location
- Practice location
- 2 BROADWAY STREET
- City
- GORHAM NH
- Postal code
- 03581
- Phone
- 603-466-2741
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.