| NPI | 1366467458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 71847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 71847) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2013-10-08 |