| NPI | 1962685545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.31935) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 31935) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2023-07-31 |