| NPI | 1194783993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX K6241) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX K6241) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2013-02-28 |