| NPI | 1003813478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NV 8476) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A63401) |
| 208600000X Surgery (Licence: CA A63401) | |
| 208D00000X General Practice (Licence: CA A63401) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2018-03-17 |