| NPI | 1164461091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 019550) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 19550) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2019-10-16 |