| 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 |