| NPI | 1124340377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME106405) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17830) |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2023-07-22 |