| NPI | 1235382821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14499) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR DM 14474-5) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2015-05-19 |