| NPI | 1265577910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 19168) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 5375) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2023-03-07 |