| NPI | 1700027844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: DC MD18079) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0025173) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2009-03-19 |