| NPI | 1225664659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101274791) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101274791) |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2026-06-15 |