| NPI | 1033900642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0108092) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT234366) |
| Enumeration Date | 2025-05-14 |
| Last Update Date | 2026-09-01 |