| NPI | 1134394034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A52544) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A52544) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2015-02-09 |