| NPI | 1477615615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME91655) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME91655) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2019-08-14 |