| NPI | 1396875563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: TX L9090) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L9090) |
| 208D00000X General Practice (Licence: TX L9090) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2026-02-06 |