| NPI | 1164419081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD H0061922) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MD H0061922) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2018-05-14 |