| NPI | 1578517827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 22106) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 22106) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2007-07-09 |