| NPI | 1699205310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME164531) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19666) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2024-07-12 |