| NPI | 1700364478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 022225) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14911-I) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2021-06-01 |