| NPI | 1154827525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: NC 2020-04244) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 1123456) |
| 208D00000X General Practice (Licence: NC 2020-04244) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2021-05-04 |