| NPI | 1508007220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CT 47782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 47782) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2021-11-11 |