| NPI | 1740391341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME25826) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME0025826) |
| 208D00000X General Practice (Licence: FL ME0025826) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-12-22 |