| NPI | 1326326588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 032159) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC MD32127) |
| 208D00000X General Practice (Licence: TX E9170) | |
| 208D00000X General Practice (Licence: MN 22017) | |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2011-07-21 |