| NPI | 1487261483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: OK R0106106) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OK Roo106106) |
| 208800000X Urology (Licence: OK R0106106) | |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2024-03-26 |