| NPI | 1053308635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9800281) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 9800281) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2019-10-07 |