| NPI | 1912145707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD MD0068492) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MD MD0068492) |
| 208600000X Surgery (Licence: MD MD036446) | |
| 208600000X Surgery (Licence: MD MD0068492) | |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2021-12-15 |