| NPI | 1912434978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 32695) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301504269) |
| 208D00000X General Practice (Licence: NE 34900) | |
| 208600000X Surgery (Licence: MI 4301112876) | |
| Enumeration Date | 2017-05-20 |
| Last Update Date | 2023-11-21 |