| NPI | 1215995097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: RI 5003) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI 05003) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2019-08-28 |