| NPI | 1699297788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 84308) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19722) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2020-03-12 |