| NPI | 1790976355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 36032-20) |
| Additional Taxonomies | 172A00000X Driver (Licence: NY 188117) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2025-04-18 |