| NPI | 1902075989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0050501) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO MDR5E56) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |