| NPI | 1255350112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G1348) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX G1348) |
| 208600000X Surgery (Licence: TX G1348) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2010-01-15 |