| NPI | 1578731428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A305820) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A305820) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2010-06-23 |