| NPI | 1235398611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 52482) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 52482) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2020-06-03 |