| NPI | 1851773196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: HI MD19130) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI 19130) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2023-03-06 |