| NPI | 1417022070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 015516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 015516) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2017-08-08 |