| NPI | 1467637744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 006170) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT 011135) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2023-09-25 |