| NPI | 1992722441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101238613) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101238613) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-10-12 |