| NPI | 1770521650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 053529) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 46018) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2014-12-15 |