| NPI | 1194109066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OK 31329) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OK 31329) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2021-08-17 |