| NPI | 1508187733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR DO173039) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR PG151472) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2020-11-10 |