| NPI | 1285955922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 245132) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 245132) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2016-10-11 |