| NPI | 1497863518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA os008967L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA os008967l) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2020-12-29 |