| NPI | 1609534841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22907) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15809I) |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2022-08-02 |