| NPI | 1568950160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA 334144) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 62892) |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2022-11-29 |