| NPI | 1851349468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01616) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY 02953) |
| 208600000X Surgery (Licence: NC 2012-01616) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2013-10-08 |