| NPI | 1457353310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME#0033481) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME33481) |
| 208600000X Surgery (Licence: FL ME#0033481) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2010-07-02 |