| NPI | 1285222125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OK 37766) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK MD37766) |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2021-01-06 |