| NPI | 1770584054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 33980) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 33980) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-05-08 |