| NPI | 1336854314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23655) |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2024-04-02 |