| NPI | 1750409942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D5918) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: TX D5918) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |