| NPI | 1891738514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G8814) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX G8814) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-03-17 |