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 |