NPI | 1497998256 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: MS 11282) |
Additional Taxonomies | 208D00000X General Practice (Licence: MN 39529) |
Enumeration Date | 2009-04-09 |
Last Update Date | 2009-04-09 |