| NPI | 1740543339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 55532) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME122338) |
| 208D00000X General Practice (Licence: GA 81093) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2024-10-01 |