| NPI | 1528347796 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC68359) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL33932) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2023-04-20 |