NPI | 1083833677 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: MO 2002023835) |
Additional Taxonomies | 208D00000X General Practice (Licence: KS 29721) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2012-08-13 |