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 |