| NPI | 1124040266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX J1570) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX J1570) |
| 208600000X Surgery (Licence: WI 2334) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-01-31 |