| NPI | 1003844812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 21139) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101246769) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2012-08-06 |