| NPI | 1487608857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A062178) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 21493) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2016-08-13 |