| NPI | 1720240690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX Q4323) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 70682) |
| 208D00000X General Practice (Licence: TX Q4323) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2026-01-27 |