| NPI | 1902108004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX N8071) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N8071) |
| 208600000X Surgery (Licence: TX N8071) | |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2010-12-01 |