| NPI | 1104838390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NM A-700-79) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM a700) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2018-04-06 |