| NPI | 1699720854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14524) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 14524) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2024-07-16 |