| NPI | 1720223175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D72797) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI MD-14431) |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2012-02-24 |