| NPI | 1861472508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D2350) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX D2350) |
| 208600000X Surgery (Licence: TX D2350) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2013-08-27 |