| NPI | 1982063178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME153783) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ACN766) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2023-07-31 |