| NPI | 1659351062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME0042452) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 14273) |
| 208D00000X General Practice (Licence: LA 016762) | |
| 208D00000X General Practice (Licence: NC 200300056) | |
| 208D00000X General Practice (Licence: OK 22628) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2019-11-15 |