| NPI | 1457302747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301111024) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 10432) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-02-07 |