| NPI | 1831136241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME38307) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME38307) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2008-12-26 |