| NPI | 1629119425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX H8854) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX H8854) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |