NPI | 1316056419 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: LA MD03347R) |
Additional Taxonomies | 174400000X Specialist (Licence: LA 03347R) |
Enumeration Date | 2006-08-30 |
Last Update Date | 2008-06-18 |