| NPI | 1417363870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME132058) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19449) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2019-11-04 |