| NPI | 1942284674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 107182) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 107182) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2016-04-04 |