| NPI | 1235529116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME136842) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13494-I) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2024-09-24 |