| NPI | 1366536344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MD041220E) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA md041220e) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2014-12-04 |