| NPI | 1174522361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 16975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 16975) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2019-11-25 |