| NPI | 1497189971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME132746) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19194) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2023-03-07 |