| NPI | 1871852095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2018-01943) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 27572) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2019-01-30 |