| NPI | 1366647497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: LA 018502) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MS 14295) |
| 208D00000X General Practice (Licence: FL 71044) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2007-07-08 |