| NPI | 1619140761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 61772) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 061772) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2020-10-05 |