| NPI | 1679995245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 1316) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21499) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2024-06-27 |