| NPI | 1992881049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME136067) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16672) |
| 208D00000X General Practice (Licence: FL ACN442) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2021-06-18 |