| NPI | 1588842611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX E2997) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TX E2997) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX E2997) | |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2015-09-07 |