| NPI | 1457884090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 32175) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 32175) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2024-06-17 |