| NPI | 1376727560 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 16974) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 16974) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2022-10-21 |