| NPI | 1033155742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 30832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0030832) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2021-05-05 |