| NPI | 1689608192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ND 3622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 3622) |
| 208600000X Surgery (Licence: MN 24007) | |
| 208D00000X General Practice (Licence: ND 3622) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-01-12 |