| NPI | 1609618743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23729) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL acn1670) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2025-04-04 |