| NPI | 1487095980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 006658) |
| 208600000X Surgery (Licence: PA OT015416) | |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2021-05-21 |