| NPI | 1093877292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2005-01383) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200501383) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2024-09-11 |