| NPI | 1083998090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME122090) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 28653-R) |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2026-02-25 |