| NPI | 1487969598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO 35249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD20288) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2021-05-05 |