| NPI | 1164814034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 19914) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: PR 19914) |
| 207L00000X Anesthesiology (Licence: PR 19914) | |
| 207N00000X Dermatology (Licence: PR 19914) | |
| 207P00000X Emergency Medicine (Licence: PR 19914) | |
| 207Q00000X Family Medicine (Licence: PR 19914) | |
| 207R00000X Internal Medicine (Licence: PR 19914) | |
| 207V00000X Obstetrics & Gynecology (Licence: PR 19914) | |
| 207X00000X Orthopaedic Surgery (Licence: PR 19914) | |
| 208000000X Pediatrics (Licence: PR 19914) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: PR 19914) | |
| 208200000X Plastic Surgery (Licence: PR 19914) | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: PR 19914) | |
| 208600000X Surgery (Licence: PR 19914) | |
| 208800000X Urology (Licence: PR 19914) | |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-03-02 |