| NPI | 1881234029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 023250) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15047-I) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2023-05-25 |