| NPI | 1700975406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME57848) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME57848) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2014-04-16 |