| NPI | 1922056019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 18888) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 18888) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2007-12-06 |