| NPI | 1770510901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA C55339) |
| Additional Taxonomies | 208600000X Surgery (Licence: GU M-1695) |
| 208D00000X General Practice (Licence: MI 31469) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2013-01-29 |