| NPI | 1073957049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OK 5554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 5554) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2026-04-14 |