| NPI | 1538423637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MN 58288) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125061837) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-05-09 |