NPI | 1336860782 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 23528) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 16045I) |
Enumeration Date | 2022-09-05 |
Last Update Date | 2023-10-20 |