| NPI | 1982613683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MS 21733) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MS 21733) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-09-25 |