| NPI | 1013987064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO R8D67) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 16268) |
| 208D00000X General Practice (Licence: KS 04-19991) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2019-12-05 |