| 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 |