NPI | 1528220142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: FL ME108338) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 17201) |
Enumeration Date | 2008-06-25 |
Last Update Date | 2022-07-21 |