| NPI | 1649584962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 49279) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS T-2349) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2012-12-18 |