| NPI | 1568761831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA G88279) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI MD-14796) |
| 208D00000X General Practice (Licence: IL 036-079008) | |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2013-01-01 |