| NPI | 1790970788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME136720) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN371) |
| 208D00000X General Practice (Licence: PR 018044) | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 07-164) | |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2022-10-20 |