| NPI | 1053348243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 36760-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 36760-020) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2011-05-06 |