| NPI | 1639492465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 53737020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53737-20) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2011-10-13 |