| NPI | 1487176566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL acn970) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19716) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2019-01-09 |