| NPI | 1588658702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 055345) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101237160) |
| 208D00000X General Practice (Licence: CA A84102) | |
| 208D00000X General Practice (Licence: FL me96329) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2009-06-03 |