| NPI | 1225501034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A182240) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A182240) |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2023-08-24 |