| NPI | 1508823329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA MD-03687R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA MD3687R) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2016-12-27 |