| NPI | 1548400500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: OK 5058) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 10402) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2023-09-19 |