| 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 |