| NPI | 1497183388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101254394) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 052491) |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2019-07-25 |