| NPI | 1326003732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 125555) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13328) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-08-10 |