NPI | 1700092863 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: PA OS003275L) |
Additional Taxonomies | 208D00000X General Practice (Licence: WV 1427) |
Enumeration Date | 2007-05-15 |
Last Update Date | 2007-07-08 |