| NPI | 1376026781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 1109) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21116) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2022-03-08 |