| NPI | 1982826152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14863) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR FA2087713) |
| 208D00000X General Practice (Licence: PR DM 139691) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2023-09-27 |