| NPI | 1386876167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA R8842) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA 4149) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2011-01-25 |