| NPI | 1538163142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 0000-28821) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 33171) |
| 208D00000X General Practice (Licence: SC MD33171) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2024-10-30 |