| NPI | 1699919878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A155413) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0080949) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2021-01-11 |