| NPI | 1134884331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ TP01042) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G44542) |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2021-11-02 |