| NPI | 1760426563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 04305) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS 04305) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2018-02-01 |