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 |