NPI | 1700852407 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208600000X Surgery (Licence: MA 72633) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 72633) |
Enumeration Date | 2006-02-23 |
Last Update Date | 2014-07-23 |