| NPI | 1770551665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR C-7455) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR C7455) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2013-12-12 |