| NPI | 1619397957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TN 51914) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 51914) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2019-05-13 |