| NPI | 1871850362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1218) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME171792) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2025-05-05 |