| NPI | 1295355220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 100735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 261851) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2024-08-01 |