| NPI | 1437111440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME42526) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 82687) |
| 208D00000X General Practice (Licence: TN 59920) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2020-01-29 |