| NPI | 1376661009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX E4179) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX E4179) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2010-10-01 |