| NPI | 1578717989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12745) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102202491) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2015-07-24 |