| NPI | 1568572725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR MD161469) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A26561) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-06-10 |