| NPI | 1841821030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22588) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15056-I) |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2022-03-15 |