| NPI | 1821428996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 37239) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL me0066158) |
| 208D00000X General Practice (Licence: MS 20192) | |
| 208D00000X General Practice (Licence: TX m7182) | |
| 208D00000X General Practice (Licence: VA 0101241120) | |
| 208D00000X General Practice (Licence: CA g68698) | |
| 208D00000X General Practice (Licence: NY 7929291) | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2013-11-26 |