| NPI | 1578828869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME140633) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13116I) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2024-01-03 |