| NPI | 1861580300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 7372) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: PR 7372) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2017-01-12 |