| NPI | 1336727841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX V9899) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX V9899) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-07-30 |