| NPI | 1275619363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101040126) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101040126) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2010-01-21 |