| NPI | 1053520023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR MD28937) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR LL16042) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-02-11 |