| NPI | 1134579048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 39348) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL39348) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2021-06-16 |