| NPI | 1891714101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A106748) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A106748) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-07-21 |