| NPI | 1578087250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 32752) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 33394) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2024-04-01 |