| NPI | 1790893931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 23886) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-30833) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2014-05-30 |