| NPI | 1285310458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PR 37695-R) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 37695-R) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2026-01-05 |