| NPI | 1578057428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: DC 10761) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D23058) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2018-06-14 |