| NPI | 1356360655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: SD 7261) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34101583) |
| 207Q00000X Family Medicine (Licence: IN 02003160A) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-09-18 |