| NPI | 1992039093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 4745) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI L1417691) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2019-03-22 |