| NPI | 1588928923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 27501) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 123456) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-09-14 |