NPI | 1144663881 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: SC 11279) |
Additional Taxonomies | 208D00000X General Practice (Licence: GA 15978) |
Enumeration Date | 2013-04-11 |
Last Update Date | 2013-04-11 |