| NPI | 1396906855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N7266) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10032224) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2011-09-16 |