| NPI | 1235216888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL MR95369) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35072292) |
| 208600000X Surgery (Licence: FL ME95369) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-04-22 |