| NPI | 1518499417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 89857) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2020037209) |
| 208D00000X General Practice (Licence: MN 69856) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2021-10-21 |