| NPI | 1992730881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 043158) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 043158) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-06-24 |