| NPI | 1649839937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL TRN29145) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 97616) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2023-12-15 |