| NPI | 1467061143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 85700) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101280452) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2025-08-24 |