| NPI | 1841542503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME135094) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ZZ ME135094) |
| 208D00000X General Practice (Licence: PR 13,114-I) | |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2024-01-18 |