| NPI | 1295466514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23491) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16089-I) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2023-09-08 |