| NPI | 1679134274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 022157) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15142I) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2021-08-09 |