| NPI | 1427334747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101249887) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101249887) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2020-02-27 |