| NPI | 1760674345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101242248) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101242248) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2025-01-13 |