| NPI | 1831658087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-127027) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 323689) |
| 208600000X Surgery (Licence: MT MED-PHYS-LIC-127027) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-03-07 |