| NPI | 1093090094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME140372) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19265) |
| Enumeration Date | 2011-10-21 |
| Last Update Date | 2025-05-12 |