| NPI | 1396708566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 35724) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 35724) |
| 208D00000X General Practice (Licence: KY 35724) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2013-01-10 |