| NPI | 1457328304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 80086) |
| Additional Taxonomies | 2086S0129X (Licence: MA 80086) |
| 208D00000X General Practice (Licence: MA 80086) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2010-07-02 |