| NPI | 1568571404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 39486) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 226835) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-01-28 |