NPI | 1154814010 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 22030) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 14742I) |
Enumeration Date | 2018-06-14 |
Last Update Date | 2024-04-30 |