NPI | 1811983877 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208D00000X General Practice (Licence: LA 05101R) |
Additional Taxonomies | 208600000X Surgery (Licence: LA 05101R) |
Enumeration Date | 2005-09-26 |
Last Update Date | 2018-10-17 |