| NPI | 1942529730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN DO 1256) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 0S0007493) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2010-05-19 |