| NPI | 1366460149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME17657) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 17657) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-03-05 |