| NPI | 1720243298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX F3589) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX F3589) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2010-12-06 |