| NPI | 1609024306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: DC DO034405) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102203355) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2014-09-24 |