| NPI | 1114165321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-01904) |
| Additional Taxonomies | 208600000X Surgery (Licence: DE C1-0009706) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2013-12-09 |