| NPI | 1285652735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC VL205) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 105969) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-09-07 |