| NPI | 1831204288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ID O-0668) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 20A7380) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2026-02-25 |