| NPI | 1588669626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO 39611) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G56102) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2007-07-08 |