| NPI | 1811395296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL LL492) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL LL492) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2014-12-16 |