| NPI | 1285211714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 35475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 35475) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-07-01 |