| NPI | 1972182533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME167122) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0101859) |
| 208D00000X General Practice (Licence: CA A193111) | |
| 208D00000X General Practice (Licence: VA 0101281685) | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2025-11-07 |