| NPI | 1053960088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 83221) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 83221) |
| 208D00000X General Practice (Licence: SC 83221) | |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2023-11-02 |