| NPI | 1629053046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0011106) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0057210) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2021-03-30 |