| NPI | 1407134034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KS 05-45083) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 60657764) |
| 208D00000X General Practice (Licence: MD H74875) | |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2022-05-25 |