| NPI | 1629267133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301091134) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301091134) |
| Enumeration Date | 2007-10-21 |
| Last Update Date | 2012-04-02 |