| NPI | 1558663526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS19319) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: FL PA9105765) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2023-12-08 |