| NPI | 1386824977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 045861) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A103289) |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2011-11-02 |