| NPI | 1790379204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102207477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101275839) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2022-08-11 |