| NPI | 1386762490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: HI 3200) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01057638A) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |