| NPI | 1265752356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 05736) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MS 05736) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2010-06-11 |