| NPI | 1487618096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME66447) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0066447) |
| 207R00000X Internal Medicine (Licence: FL ME66447) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2022-11-17 |