| NPI | 1316265515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 38979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 38979) |
| 207U00000X Nuclear Medicine (Licence: SC 38979) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2022-03-03 |