| NPI | 1568628139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME163136) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101253456) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2025-02-12 |