| NPI | 1447215298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NC 01446) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD M67394) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2020-10-20 |