| NPI | 1063608958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PR 18112) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT191873) |
| 208D00000X General Practice (Licence: PR 18112) | |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2015-06-24 |