| NPI | 1124242193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 0000012779) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 022204) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |