| NPI | 1154776755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 30177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0028577) |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2025-12-10 |