| NPI | 1801915111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101026028) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101026028) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2023-03-07 |