| NPI | 1356630867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AK 3595) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 0036955) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2011-07-28 |