| NPI | 1992010433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q2833) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY AC4187868124) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2015-11-25 |