| NPI | 1457977084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME155903) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 30792) |
| 208600000X Surgery (Licence: MN 69653) | |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2024-03-05 |