| NPI | 1992959712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME120432) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 072756) |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2014-09-19 |