NPI | 1942288618 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: NC 3801) |
Additional Taxonomies | 208D00000X General Practice (Licence: WV 14099) |
Enumeration Date | 2006-01-04 |
Last Update Date | 2024-08-28 |