| NPI | 1407899610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 026820) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: CT 026820) |
| 208600000X Surgery (Licence: CT 026820) | |
| 207Q00000X Family Medicine (Licence: CT 026820) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2017-01-19 |