| NPI | 1245216522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME140764) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14375) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2024-03-28 |