| NPI | 1386914794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0009598) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0009598) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2012-01-03 |