| NPI | 1578654448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101024299) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101024299) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |