| NPI | 1811086952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 20A4758) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A4758) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2019-06-20 |