| NPI | 1073509170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101021882) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101021882) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2012-10-29 |