| NPI | 1275759367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OK 28754) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01036853) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2014-10-30 |