| NPI | 1447439872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WY 2139A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 26101) |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2007-11-01 |