| NPI | 1548791981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-03787) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 227101) |
| 207Q00000X Family Medicine (Licence: NC 227101) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2021-07-08 |