| NPI | 1225535438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 008077) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 17691) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2021-09-24 |