| NPI | 1851779367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 29429) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 29429) |
| 207R00000X Internal Medicine (Licence: MD P31340) | |
| Enumeration Date | 2015-05-16 |
| Last Update Date | 2022-03-10 |