| NPI | 1538786298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX BP10086955) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ND 17577) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-03-11 |