| NPI | 1780636605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME159168) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 30402) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-08-10 |