| NPI | 1215107883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI 2500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 2500) |
| 261Q00000X (Licence: HI 2500) | |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2021-12-01 |