| NPI | 1265871131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-12496) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 13518522-1204) |
| 208600000X Surgery (Licence: PA OT015216) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2023-09-12 |