| NPI | 1922322940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA 205704) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 23241) |
| 208D00000X General Practice (Licence: AL 32590) | |
| 208D00000X General Practice (Licence: FL 8987) | |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2021-09-28 |