| NPI | 1033430327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME143503) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 261987) |
| 208D00000X General Practice (Licence: NC 2010-01073) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2021-04-08 |