| NPI | 1629278221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 241998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 241998) |
| 208D00000X General Practice (Licence: MA 241998) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2019-05-31 |