| NPI | 1255644787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 25900) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE Pending) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2013-01-15 |