| NPI | 1881129302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN 68916) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 68916) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2025-04-29 |