| NPI | 1073931358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 66514-20) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 66514-20) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2022-10-25 |