| NPI | 1356543466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME127290) |
| Additional Taxonomies | 208D00000X General Practice (Licence: RI MD10184) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2017-01-25 |