| NPI | 1588285910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ R78026) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 1588285910) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2024-11-14 |