| NPI | 1235556481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 91885) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 55130) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2024-10-30 |