| NPI | 1912145707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MD MD0068492) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD MD0068492) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MD MD0068492) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: MD MD0068492) | |
| 208600000X Surgery (Licence: MD MD036446) | |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2026-06-09 |