NPI | 1609945294 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208D00000X General Practice (Licence: FL 051866) |
Additional Taxonomies | 174400000X Specialist (Licence: FL ME51866) |
Enumeration Date | 2006-11-07 |
Last Update Date | 2009-05-19 |