| NPI | 1063491504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 032891) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 032891) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2012-11-05 |