| NPI | 1487751871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME88595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME88595) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-04-05 |