| NPI | 1164512893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A26621) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A26621) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-08-27 |