| NPI | 1255304903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR MD175323) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD175323) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2025-07-30 |