| NPI | 1821415944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A163300) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A163300) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2025-09-23 |