| NPI | 1265400840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 12583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 12583) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2011-10-15 |