| NPI | 1578640231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9800713) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 16430) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-05-14 |