| NPI | 1033853270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101280215) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC MD500002422) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2023-12-27 |