| NPI | 1700830601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 41584) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NC 26371) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 26371) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2012-02-21 |