| NPI | 1427000504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101235033) |
| Additional Taxonomies | 208D00000X General Practice (Licence: DC MD15742) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-07-08 |