| NPI | 1578990438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ANC889) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 018814) |
| Enumeration Date | 2013-10-08 |
| Last Update Date | 2022-09-02 |