| NPI | 1457510810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 46276) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0067584) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2021-12-08 |