| NPI | 1932395415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 55782) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A51203) |
| 208D00000X General Practice (Licence: KY 28318) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2014-01-16 |