| NPI | 1831776699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI dos-2325-0) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 7812) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2022-08-30 |