| NPI | 1235101676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C10005740) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DE CI0005740) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2015-05-18 |