| NPI | 1699767301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 20430-020) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 20430-020) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2023-09-08 |