| NPI | 1609854934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX L5537) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX L5537) |
| 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: TX L5537) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2013-12-27 |