| NPI | 1487651717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 21942) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 21942) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2023-10-12 |