| 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 |