| NPI | 1295734937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H4136) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 1598) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2012-01-11 |