| NPI | 1952412637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME53582) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0053582) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-12-05 |