| NPI | 1336189067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G74901) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G74901) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-10-09 |