| NPI | 1568451318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 95760) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 018256) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2021-03-23 |