| NPI | 1083612527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 12034) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PR 12034) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2025-04-25 |