| NPI | 1841351061 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35057674) | 
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35057674) | 
| Enumeration Date | 2006-12-12 | 
| Last Update Date | 2025-04-18 |