| NPI | 1548377849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR R3836) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR R3836) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2016-10-05 |