| NPI | 1275784340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KS 04-13686) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX E8132) |
| 208D00000X General Practice (Licence: NC 22962) | |
| 208D00000X General Practice (Licence: CO 16023) | |
| 208D00000X General Practice (Licence: OK 8476) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2008-10-07 |