| NPI | 1861949646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21176) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14135) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2019-05-10 |