| NPI | 1902812019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR C5210) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR C5210) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2010-08-30 |