| NPI | 1366125916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 023458) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PR 023458) |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2024-03-06 |