| NPI | 1497893754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX F9189) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX f9189) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2023-03-16 |