| NPI | 1699056572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 160643) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18304) |
| 208D00000X General Practice (Licence: FL 445) | |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2023-01-25 |