| NPI | 1164683710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: VA 0101253219) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101253219) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2026-08-17 |