| NPI | 1881044873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A153321) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301110054) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-08-16 |