| NPI | 1467528638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ND 10442) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 10442) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-11-11 |