| NPI | 1376663997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 237452) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 94-06681) |
| 207Q00000X Family Medicine (Licence: NY 237452) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2016-09-19 |