| NPI | 1104815760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS006345L) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: CA 20A13886) |
| 208D00000X General Practice (Licence: CA 20A13886) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2016-12-11 |