| NPI | 1689614901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME81527) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME81527) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-11-29 |