| NPI | 1508092487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203274) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101018198) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2022-07-21 |