| 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 |