| NPI | 1710245519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D80203) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT201166) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2015-09-09 |