| NPI | 1386149342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 008515) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20508) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-10-31 |