| NPI | 1962579391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME100038) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 040883) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2023-03-07 |