| NPI | 1164786117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 56532) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MN 56532) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2016-12-14 |