| NPI | 1093974172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 38714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8768) |
| 208600000X Surgery (Licence: KS 94-06938) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2012-08-15 |