| NPI | 1104110196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 71570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 71750) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2024-04-28 |