| NPI | 1346741592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 2124) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS025309) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2026-07-08 |