| NPI | 1306892351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 031483) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 00013121) |
| 208600000X Surgery (Licence: FL ME 49553) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2013-02-21 |