| NPI | 1407032899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME 111211) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 151004) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2013-11-21 |