| NPI | 1952327686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 1166) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19419) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-07-30 |