| NPI | 1285699264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 72 154020 1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 154020-8905) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2015-09-04 |