| NPI | 1174541569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E0238) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX E0238) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-02-07 |