| NPI | 1174975734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 89869) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: SC 94207) |
| 208600000X Surgery (Licence: SC 94207) | |
| 208D00000X General Practice (Licence: SC 94207) | |
| 208600000X Surgery (Licence: GA 89869) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2025-11-13 |