| NPI | 1841229358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA MD.017140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 017140) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-08-19 |