| NPI | 1164548046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 18888) |
| 208600000X Surgery (Licence: WI 18888) | |
| 207Q00000X Family Medicine | |
| 208D00000X General Practice | |
| 207R00000X Internal Medicine | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-09-26 |