| NPI | 1902904998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A53771) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A53771) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2013-04-03 |