| NPI | 1548262108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 29105) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: AL 29105) |
| 208D00000X General Practice (Licence: AL MD29105) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2016-10-10 |