| NPI | 1184776056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS013468) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS013468) |
| 208600000X Surgery (Licence: PA OT010889) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2024-04-02 |