| NPI | 1679913628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 72840) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 006442) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2024-08-22 |