| NPI | 1265826127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 81701) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 82173) |
| 208600000X Surgery (Licence: GA 81701) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2024-08-13 |