| NPI | 1720053168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 26824) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 26824) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2025-09-11 |