| NPI | 1083268007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21974) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15162i) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2020-09-28 |