| NPI | 1437186566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 12939) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PR 12939) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2010-02-04 |