| NPI | 1497841209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301024214) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301024214) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2011-10-13 |