| NPI | 1386105005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 69100) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 69100) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2021-10-15 |