| NPI | 1407119076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX Q2911) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10044092) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2015-03-12 |