| NPI | 1588922116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD D0080390) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: MD D0080390) |
| 208600000X Surgery (Licence: FL TRN# 17199) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2026-03-16 |