| NPI | 1811537285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 22178) |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2022-03-18 |