| NPI | 1366657173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD418406) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 37056-020) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |