| NPI | 1730221466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO DR0042357) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MT MED-PHYS-LIC-43720) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2016-02-10 |