| NPI | 1588025746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102204982) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2021-02223) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2022-06-30 |