| NPI | 1396356549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22410) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15441) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2021-12-03 |