| NPI | 1588830608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 242844) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 228529) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2016-10-21 |