| NPI | 1750346128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 14706) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2022-04-08 |