| NPI | 1831169242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101247418) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 35065) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2015-06-16 |