| NPI | 1669678561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 32383) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME91690) |
| 208D00000X General Practice (Licence: NY 212283) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2015-08-12 |