| NPI | 1447558416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX Q8309) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 27405) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2016-08-30 |