| NPI | 1043550577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: ZZ 7342537) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ZZ 4607021) |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2013-02-20 |