| NPI | 1316938079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 30614) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2004010176) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2013-10-25 |