| NPI | 1770100398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 100753) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 84676) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2024-08-12 |