| NPI | 1003992975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 0039973) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 0039973) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2017-11-06 |