NPI | 1174993174 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301108674) |
Additional Taxonomies | 208D00000X General Practice (Licence: MI 5315073293) |
Enumeration Date | 2015-10-02 |
Last Update Date | 2018-07-26 |