| NPI | 1902809700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME48975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME48975) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2022-01-26 |