| NPI | 1164427811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SC 18817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18817) |
| 208600000X Surgery (Licence: GA 055731) | |
| Enumeration Date | 2005-06-18 |
| Last Update Date | 2021-10-28 |