| NPI | 1689631608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 23389) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: SC 23389) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2014-12-11 |