| NPI | 1134577976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 19733) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 13942-I) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2017-07-21 |