| NPI | 1285608364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 23658) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 23658) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2011-06-28 |