| NPI | 1811339203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME 116020) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301102709) |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2020-01-06 |