| NPI | 1487854436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 012468) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 61622) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2025-10-22 |