| NPI | 1881864197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 51008-020) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 51008-020) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2015-05-19 |