| NPI | 1962671909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 231102) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 231102) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-11-25 |