| NPI | 1528020500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101259876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101259876) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2018-08-20 |