| NPI | 1841491370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2009-00568) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2009-00568) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2016-06-17 |