| 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 |