| NPI | 1871513457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AK AA2965) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 10651) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2025-09-11 |