| NPI | 1952791287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PR 18995) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18995) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2023-08-07 |