| NPI | 1073543229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MT 3401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT MT3401) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2011-04-05 |