NPI | 1891792974 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: AZ 0970) |
Additional Taxonomies | 208D00000X General Practice (Licence: MO 32357) |
Enumeration Date | 2005-07-05 |
Last Update Date | 2007-07-08 |