| NPI | 1194245464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 19735) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14214i) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2017-11-20 |