| NPI | 1356904205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R-12116) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5151013431) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2022-05-12 |