| NPI | 1326775230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 1507) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 22898) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2023-02-11 |