| NPI | 1255307179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MA 44260) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 44260) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2025-09-11 |