NPI | 1336318906 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: PR 17040) |
Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301117215) |
Enumeration Date | 2008-02-27 |
Last Update Date | 2019-07-11 |