| NPI | 1043544810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME144314) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301092020) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2023-09-22 |