| NPI | 1639178122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101055534) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101055534) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2019-11-11 |