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 |