| NPI | 1942360052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR C5376) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: AR C5376) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2013-12-20 |