| NPI | 1528595717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME143227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME143227) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 27678) | |
| 208600000X Surgery (Licence: AZ R76171) | |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2020-04-30 |