| NPI | 1104046515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2011-01454) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2011-01454) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2023-10-12 |