| NPI | 1477168003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22004) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15143-I) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2020-11-18 |