| NPI | 1669442620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 21359) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 21359) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2015-03-17 |