| NPI | 1295915395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA 201782) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 201782) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2016-06-27 |