NPI | 1144617382 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ME172223) |
Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN723) |
208D00000X General Practice (Licence: PR 19123) | |
Enumeration Date | 2015-04-24 |
Last Update Date | 2025-03-25 |