| NPI | 1265506703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 04588R) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 04588R) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-10-08 |