| NPI | 1598043663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 72011) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 072011) |
| 208D00000X General Practice (Licence: GA 072011) | |
| Enumeration Date | 2011-07-23 |
| Last Update Date | 2023-11-17 |