| NPI | 1275569915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME 88347) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101-041039) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2012-05-03 |