| NPI | 1053475764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 62940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 48035) |
| 208600000X Surgery (Licence: MN 48035) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2021-04-27 |