| NPI | 1700185642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL MD.10713) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301041543) |
| 208D00000X General Practice (Licence: CA C40967) | |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2013-09-03 |