| NPI | 1306948930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 35018) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 35018) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2011-12-07 |