| NPI | 1780816645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CO 38110) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA C52886) |
| 208D00000X General Practice (Licence: IN 01054400A) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2009-08-11 |