| NPI | 1104034339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 26260) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 26260) |
| 208200000X Plastic Surgery (Licence: AL 26260) | |
| 208600000X Surgery (Licence: AL 26260) | |
| 208D00000X General Practice (Licence: AL 26260) | |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2023-03-09 |