| NPI | 1922301589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2014-02270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101235535) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2016-06-23 |