| NPI | 1013164854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 051039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 28927) |
| Enumeration Date | 2008-08-23 |
| Last Update Date | 2021-06-25 |