| NPI | 1558044289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G56467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G56467) |
| 208D00000X General Practice (Licence: CA G56467) | |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2023-08-09 |