| NPI | 1114915592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101031238) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0033777) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2007-07-08 |