| NPI | 1619231966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX Q5755) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR E-9281) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2015-09-08 |