| NPI | 1306241286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME150618) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN596) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2023-05-09 |