| NPI | 1851761555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD478007) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 21515) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2023-04-07 |