| NPI | 1477578698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A38312) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A38312) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-06-02 |