| NPI | 1326146978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC 81722) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 1209) |
| 207Q00000X Family Medicine (Licence: SC 81722) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-05-02 |