| NPI | 1710991344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: UT 5776819-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 57768191205) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2026-04-03 |