| 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 |