| NPI | 1225435530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME135244) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18945) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2018-06-28 |