| NPI | 1730673500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 5101027589) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS19477) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2024-04-09 |