| NPI | 1255439543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: IA 51829) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 29984) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-11-16 |