| NPI | 1952798258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL me134823) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME134823) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2020-02-17 |