| NPI | 1740930601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 010654) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS20777) |
| 208D00000X General Practice (Licence: ID 6161277) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-01-28 |