| NPI | 1649439134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 62897) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 62897) |
| 208D00000X General Practice (Licence: GA 062897) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2025-06-16 |