| NPI | 1205367570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME141965) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2024-01-01 |