| NPI | 1760453302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 18961) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IA 18961) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2008-01-17 |