| NPI | 1215125315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 9583804-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8575) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2021-12-07 |