| NPI | 1023493111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021436) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS T3046) |
| 208D00000X General Practice (Licence: AL DO 1653) | |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2022-10-24 |