| NPI | 1508198201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AR E-3485) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR E-3485) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2021-04-07 |