| NPI | 1508963950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: ND 3926) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND 3926) |
| 208600000X Surgery (Licence: SD 2268) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-03-05 |