| NPI | 1356318596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R4095) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO R4095) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2021-11-16 |