| NPI | 1588218101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2023-03338) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 34959) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2025-06-06 |