| NPI | 1730313255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 016319) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 9900932) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2009-05-12 |