| NPI | 1750690335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 27620) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 27620) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2020-10-15 |