| NPI | 1003430950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 82418-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2020014721) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2023-09-13 |