| NPI | 1669854196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND 15165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 15165) |
| 207Q00000X Family Medicine (Licence: SC LL38351) | |
| 207Q00000X Family Medicine (Licence: IA 46141) | |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2023-08-04 |