| NPI | 1710293881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL MD.30478) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME111635) |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2017-10-19 |