| NPI | 1588985550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: DE C1-0010219) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT196234) |
| 208D00000X General Practice (Licence: PA MD447902) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2023-05-25 |