| NPI | 1821396151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL me42522) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME 42522) |
| 207Q00000X Family Medicine (Licence: FL ME42522) | |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2023-12-28 |