| NPI | 1255627840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301095681) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301095681) |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2021-03-29 |