| NPI | 1710948971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 87219-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL me95263) |
| 174400000X Specialist (Licence: FL ME95263) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2026-06-18 |