| NPI | 1013905520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME151308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011013562) |
| 208600000X Surgery (Licence: MO 2011013562) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2021-11-12 |