| NPI | 1619745932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 023741) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 16593-I) |
| Enumeration Date | 2023-12-15 |
| Last Update Date | 2024-05-22 |