| NPI | 1538122478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: GA 028667) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 28667) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2014-01-23 |