| NPI | 1518294016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 077147) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101249329) |
| 208D00000X General Practice (Licence: MN 57650) | |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2019-01-23 |