| NPI | 1801934682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101029718) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101029718) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2020-02-28 |