| NPI | 1881682284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL DO58) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL D058) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2012-09-11 |