| NPI | 1457359929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME0039319) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 39313) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2015-08-17 |