| NPI | 1508146267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0065134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 29396) |
| 208600000X Surgery (Licence: MD P26746) | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2021-03-09 |