| NPI | 1770076465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020820) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA OS020820) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2021-07-15 |