| NPI | 1124524038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301510893) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MN 68449) |
| 208D00000X General Practice (Licence: KS TW00059) | |
| 208D00000X General Practice (Licence: FL TPME2986) | |
| 208D00000X General Practice (Licence: CO DR.0074417) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2026-03-15 |