| NPI | 1144452798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 006491) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NV SL0746) |
| 207Q00000X Family Medicine (Licence: MI 5101018505) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2016-02-09 |