| NPI | 1063045870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22352) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15330I) |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2021-06-22 |