| NPI | 1972535334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 75746) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 14501) |
| 208D00000X General Practice (Licence: AZ 75746) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-08-11 |