| NPI | 1073576237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI JP037662) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI JP037662) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2026-07-13 |