| NPI | 1144332552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WY 4296A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 4296A) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-05-12 |