| NPI | 1457412637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 54149) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 054146) |
| 207Q00000X Family Medicine (Licence: AL 7516) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2010-02-03 |