| NPI | 1700878634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR R4419) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR R4419) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2013-03-28 |