| NPI | 1669804720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME140780) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 020982) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2024-08-13 |