| NPI | 1942463054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME114939) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301093152) |
| 207Q00000X Family Medicine (Licence: MI 4301093152) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2016-07-15 |