| NPI | 1023219763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME133231) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME133231) |
| 208D00000X General Practice (Licence: FL ACN394) | |
| 208D00000X General Practice (Licence: WI 55147-20) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2023-03-07 |