| NPI | 1255578860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 0311) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 44513) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2025-03-25 |