| NPI | 1427127000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.054121) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 47326) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2017-02-13 |