| NPI | 1851479281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D014760) |
| Additional Taxonomies | 208600000X Surgery (Licence: DC MD6423) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2011-05-10 |