| NPI | 1023057577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14036) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 14036) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-03-07 |