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 |