| NPI | 1043241235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME47297) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME47297) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2026-08-13 |