| NPI | 1306919899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A374444) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A37444) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |