| NPI | 1598921173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11947) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125051268) |
| Enumeration Date | 2008-08-02 |
| Last Update Date | 2013-05-06 |