| NPI | 1477749810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 037841) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 037841) |
| 208D00000X General Practice (Licence: GA 037841) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2007-09-19 |