| NPI | 1023161809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME0046858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0046858) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2022-11-22 |