| NPI | 1164104428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL EO6136) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL FB9807664) |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2026-03-30 |