| NPI | 1902179534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 5182) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 5182) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2022-07-29 |