| 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 |