| NPI | 1184963969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME132585) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 020427) |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2022-06-24 |