| NPI | 1023076213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 20663) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 20663) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2015-04-28 |