| NPI | 1861473803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NM 89340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 89-340) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2016-04-04 |