| NPI | 1457712937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX D2691) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TX d2691) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2016-03-11 |