| NPI | 1447638960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO DR.0019710) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G30425) |
| Enumeration Date | 2015-05-16 |
| Last Update Date | 2015-05-16 |