| NPI | 1811090335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 8664) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 8664) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2009-07-02 |