| NPI | 1619061520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME91951) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 91951) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-08-20 |