| NPI | 1730436221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX Q3561) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101255212) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2021-11-12 |