| NPI | 1841747144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21541) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 14929I) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2020-08-31 |