| NPI | 1518329911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS12142) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: FL HCC8713) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-03-24 |