| NPI | 1124314000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0067852) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101253518) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2023-08-02 |