| NPI | 1366483919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0047056) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D47056) |
| 208600000X Surgery (Licence: MD D0047056) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2022-01-31 |