| NPI | 1467463828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 8483) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 8483) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2010-06-30 |