| NPI | 1396763421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KS 04-34103) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2004005751) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-04-15 |