NPI | 1235329558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ME100080) |
Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME100080) |
Enumeration Date | 2007-08-01 |
Last Update Date | 2025-02-05 |