| NPI | 1649597105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101282285) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 165904) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2026-05-31 |