| NPI | 1730184821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX M0313) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M0313) |
| 174400000X Specialist (Licence: TX 025423) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2023-06-14 |