NPI | 1972759439 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101264599) |
Additional Taxonomies | 208D00000X General Practice (Licence: FL ME125435) |
208600000X Surgery (Licence: PA MT192755) | |
Enumeration Date | 2008-08-14 |
Last Update Date | 2019-02-20 |