| NPI | 1780176768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21993) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14698) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2020-10-15 |